Very bad drooping smile at 44 - how can I lift my smile? (Photos)

Question

Help is there anything I can do to lift my smile it’s just getting worse I can feel it sagging and weighing down. I am a little afraid to get the Botox in the DAO in fear of being all crooked. Would that even help or make it worse? I have the bigger chunk of fat on the right not sure why.

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your photos and being so open about your concerns. I want to reassure you right away: what you’re noticing is very common in our 40s, and it does not mean you’re doing anything wrong or that your face is “failing.” This is a normal, anatomical change—and there are thoughtful ways to address it.

Why your smile feels heavy or droopy

What I’m seeing and what you’re describing is a combination of:

Strong downward pull from the DAO muscles, which naturally become more dominant with age

Loss of structural support around the mouth and lower face

Descent of facial fat, which can create that “weighing down” sensation

Normal asymmetry—most people have one side that’s heavier or stronger (often the chewing side)

So this isn’t just one problem; it’s a balance issue between muscles and support.

About DAO Botox (and your fear of looking crooked)

Your concern is completely valid. Poorly placed or excessive DAO Botox can make a smile feel weak or uneven.

That said, when done conservatively and precisely, DAO Botox usually:

Softens the downward pull at the mouth corners

Allows your natural smile elevators to work better

Improves the resting expression without freezing movement

The key is very small doses and symmetry awareness. Often both sides are treated—even if one side looks worse—to maintain balance. When patients end up unhappy, it’s almost always from overtreatment, not from the concept itself.

Why Botox alone may not be enough

If you’re already feeling heaviness and sagging, Botox by itself may help somewhat, but it won’t replace lost support. In patients around your age, the most natural results usually come from a combined approach, which may include:

Subtle structural support (not directly in the corner of the mouth)

Carefully dosed DAO Botox

Sometimes addressing nearby muscles that contribute to tension or downward pull

This approach lifts the appearance of the smile without changing who you are or how you express yourself.

About the “bigger chunk” on the right side

This is extremely common and usually due to:

Natural facial asymmetry

Muscle dominance

Long-standing habits like chewing or sleeping patterns

It doesn’t mean anything is wrong—it just means treatment should be customized, not one-size-fits-all.

My honest reassurance

You are not too young, not too old, and not beyond help.
You do not need aggressive treatment.
And no—you don’t need to sacrifice your smile to improve it.

The goal is always to rebalance, support, and soften, not to freeze or distort. With the right approach, improvements should look natural and feel like you, just more rested and lifted.

Very bad drooping smile at 44 - how can I lift my smile? (Photos)

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